A 19-year-old in her third trimester complains of a headache and blurred vision. During transport, she begins seizing. What should you suspect?

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Multiple Choice

A 19-year-old in her third trimester complains of a headache and blurred vision. During transport, she begins seizing. What should you suspect?

Eclampsia occurs when preeclampsia progresses to seizures during pregnancy, typically after 20 weeks. The combination of being in the third trimester with new-onset headaches and visual changes signals preeclampsia, and the onset of a seizure confirms the progression to eclampsia. The underlying issue is abnormal placentation leading to endothelial dysfunction and cerebral vasospasm with edema, which can provoke severe headaches, vision disturbances, and seizures. In this scenario, the seizure during transport in a late-pregnant patient with prior warning signs is most consistent with eclampsia. Immediate management focuses on protecting the patient and fetus while preparing for definitive care: ensure airway and breathing, place the patient on her left side, give high-flow oxygen, establish IV access, and follow your protocol for treating preeclampsia/eclampsia (often including magnesium sulfate to prevent further seizures and control blood pressure with appropriate antihypertensives). Rapid transport to an obstetric facility is essential, as delivery is the definitive treatment once mother and fetus are stabilized. Meningitis would present with fever and neck stiffness and wouldn’t neatly explain a seizure in this late-pregnancy context. A stroke could cause similar symptoms but is less likely given the classic triad of third-trimester pregnancy with new headaches and visual changes progressing to a seizure. A hypertensive emergency without seizure fits the elevated blood pressure picture but lacks the seizure event that defines eclampsia.

Eclampsia occurs when preeclampsia progresses to seizures during pregnancy, typically after 20 weeks. The combination of being in the third trimester with new-onset headaches and visual changes signals preeclampsia, and the onset of a seizure confirms the progression to eclampsia. The underlying issue is abnormal placentation leading to endothelial dysfunction and cerebral vasospasm with edema, which can provoke severe headaches, vision disturbances, and seizures.

In this scenario, the seizure during transport in a late-pregnant patient with prior warning signs is most consistent with eclampsia. Immediate management focuses on protecting the patient and fetus while preparing for definitive care: ensure airway and breathing, place the patient on her left side, give high-flow oxygen, establish IV access, and follow your protocol for treating preeclampsia/eclampsia (often including magnesium sulfate to prevent further seizures and control blood pressure with appropriate antihypertensives). Rapid transport to an obstetric facility is essential, as delivery is the definitive treatment once mother and fetus are stabilized.

Meningitis would present with fever and neck stiffness and wouldn’t neatly explain a seizure in this late-pregnancy context. A stroke could cause similar symptoms but is less likely given the classic triad of third-trimester pregnancy with new headaches and visual changes progressing to a seizure. A hypertensive emergency without seizure fits the elevated blood pressure picture but lacks the seizure event that defines eclampsia.

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